Available online 22 November 2023, 101495

. Randomized controlled trials (RCTs) have demonstrated the superiority of metabolic surgery (MS) over medical therapy (MT) in patients with obesity and type 2 diabetes, leading, to a joint statement in 2016 proposing MS to patients with class I obesity and uncontrolled glycemia. Yet, these RCTs included few patients with class I obesity (body mass index 30 to 35 kg/m2) and even fewer patients with overweight. Our aim was to provide an updated systematic review (SR) with meta-analysis (MA) of RCTs reporting diabetes remission (DR) after MS in these patients.

. We included in the SR with MA only RCTs with at least 24-month follow-up found in Medline, Cochrane Library, Embase, and LiSSA between January 2008 to September 2022 comparing DR post-MT versus post-MS. We calculated relative risk (RR) and 95% confidence intervals (CIs) using the Mantel-Haenszel random-effects approach to examine differences in DR between patients allocated to MS versus MT.

. DR was significantly higher in MS versus MT after 36 months’ follow-up in patients with obesity (RR=6.65 [95%CI 2.24;19.79]; I² = 27%; 5 trials, 404 patients), but also specifically in patients with class I obesity (RR=5.27 [1.31;21.23]; I²=0%; 4 trials, 80 patients). Furthermore, and in line with previous results, all additional MAs performed in patients with obesity in this work favor MS (specifically Roux-en-Y gastric bypass) over MT at 24, 36 (only) and 60 months of follow-up.

. Although the data available in patients with class I obesity and type 2 diabetes remains limited, MA shows higher rates of DR after MS compared with MT after 36 months’ follow-up in these patients. Consequently, the French National Authority for Health French (HAS) recommends MS for these patients.

Bariatric surgery

Meta-analysis

Metabolic surgery

Obesity

Remission

Type 2 diabetes

© 2023 The Author(s). Published by Elsevier Masson SAS.